Provider Demographics
NPI:1588962039
Name:BAKER, ANGELA L (RPH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:L
Other - Last Name:WILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:PO BOX 5087
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29938-5087
Mailing Address - Country:US
Mailing Address - Phone:704-877-5396
Mailing Address - Fax:
Practice Address - Street 1:1294 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-6143
Practice Address - Country:US
Practice Address - Phone:843-522-8503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8516183500000X
NC12301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist